Why painkiller addiction is becoming such a problem in the UK

I was concerned recently to see that data just released by the UK Addiction Treatment (UKAT) Centres showed that in the last two years admissions across their six UK-wide treatment centres for over-the-counter painkillers such as codeine, and benzodiazepines prescribed by GPs had risen by 17 per cent.

This confirms a general UK trend of more people becoming dependent on both prescribed and over the counter (OTC) medication, something I now see in my surgery compared to previous years.

I classify addiction as being when someone becomes physically and psychologically dependent on a substance (although not all drugs can cause physical dependence) and so feel they cannot do without a drug, with a craving for it if they are unable to take it for a period of time.

One of the problems here is that many people do not realise that for many OTC painkillers, the active ingredient is codeine and it is this narcotic that has a significant potential for addiction if over-used or even if used regularly for long periods of time.

There can be a subtle difference between dependence on a drug and addiction to it too – you can be physically dependent on a drug but not addicted to it. Physical dependence on a drug means that your body has built up tolerance to its effects and so bigger and bigger doses of the same drug are required to get the same effect and many people taking OTC painkillers find this is the case over time. When you're addicted to a drug however, this is more than physical as you keep taking it even when it is causing major problems in your life such as its impact on work, finances, relationships and health.

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There are a number of signs to look for if you or someone you know may be becoming dependent on a drug. These include:

Finding it difficult to cut down or stop the drug

Needing to take increasing quantities of the drug to get the same effect

Being secretive, or feeling guilty about taking a drug

Asking for repeat prescriptions early

Having arguments with other people about your drug intake

Having work or financial problems due to taking the drug

Tell-tale signs of painkiller addiction

So, what are the tell-tale signs that someone may be hooked on their painkillers – either OTC or prescribed by their doctor? Everybody is different here but there are some key signs to look out for that can give your friend away;

1. They stock up on painkillers

Always making sure they have lots available at work, home, in the car and in different bags. To do this they may have to visit different pharmacists or supermarkets to buy the quantities they need. There are restrictions - pharmacists are not supposed to sell more than one pack of 24 tablets of codeine-based painkillers at a time - so they may stock up whenever they can.

2. They think about their painkillers a lot

when their next dose is due, and if they have enough available to them. If they are in acute pain, that's reasonable but if they aren't they may have a dependence problem. They may also stretch out the time between doses or shrink some doses so they can take more later – another warning sign.

3. They get snappy, irritable, tired or have significant mood swings

For no obvious reason. If they feel defensive or irritated when questioned as to why, they may have a problem here. If their sleep patterns change or they take less interest in their personal appearance these can also be worrying signs.

4. They seem to obtain painkillers from different sources

As well as buying them from different parts of the high street, they may also by them online, or even use left-over prescription drugs from the medicine cabinet. Beware too if they 'doctor shop' – visit different doctors in order to try to obtain further quantities of painkillers – although good medical record-keeping should highlight this as a potential problem fairly quickly.

5. They constantly complain of having a headache that only large doses of painkillers can cure

This can be a sign of a condition called 'painkiller headache' where painkillers are slowly taken in bigger quantities over time because of a headache but in fact the headache is caused by codeine withdrawal and so a vicious circle develops. It has been estimated that up to 10% of people with headaches may have them because of their painkiller usage. (Strangely, painkiller headaches only become a problem for people who take painkillers to treat headaches. They don't happen to people who take painkillers for long periods for other painful conditions, such as arthritis and back pain.)

If you are concerned that a loved one or friend may have a painkiller addiction, be honest with them and express your concerns with them as many sufferers find the strain of keeping their habit hidden too much. Trust your instincts, but remember that you cannot make someone change their habits if they choose not to. Ask them to see their doctor, who can point them towards locally available help and treatment programmes. Above all, talk about it and then talk about it some more. To your family, best friend, GP or trusted work colleague if you want – just remember that the journey to recovery always starts with that first step.

Dr Roger HendersonDr Roger Henderson qualified as a doctor and a general practitioner from St Bartholomew's Hospital, London.

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